Dosage Calculations
Order: Acetaminophen 650 mg PO now. Available: Acetaminophen 325 mg tablets. How many tablets will the nurse administer
2 Tablets
The nurse is preparing to administer enoxaparin subcutaneously. Which action demonstrates correct administration technique?
A. Massage the injection site after administration
B. Expel the air bubble from a prefilled syringe before administration
C. Administer the medication into the anterolateral or posterolateral abdomen
D. Aspirate for blood return before injecting the medication
C
Rational: Enoxaparin is administered subcutaneously in the abdomen, typically alternating sites. When using manufacturer-prepared prefilled syringes, the air bubble should not be expelled, and the nurse should not rub or aspirate the injection site because this can increase bruising.
The nurse is preparing to administer a tuberculin skin test (TST). Which location is most appropriate for the injection?
A. Abdomen
B. Inner surface of the forearm
C. Ventrogluteal area
D. Lateral thigh
B.
The inner forearm is a common site for intradermal injections such as the TST (Monteux or PPD).
A nurse administers a medication using a 25-gauge, ⅝-inch needle at a 90° angle into the fatty tissue of the abdomen. What route is being used?
Subcutaneous
he nurse enters the patient's room to administer medication. The patient says, “That's not the pill I normally take.” What should the nurse do?
Stop and verify the medication order/MAR before administering it.
Order: Amoxicillin 500 mg PO. Available: Amoxicillin 250 mg/5 mL. How many mL will the nurse administer?
10 mL
The nurse reviews the medical history of a patient who has a prescription for ketorolac. Which finding should cause the nurse to question the prescription?
A. Acute musculoskeletal pain
B. History of peptic ulcer with gastrointestinal bleeding
C. Temperature of 100.2°F (37.9°C)
D. Heart rate of 88 beats/min
B
Rational: Ketorolac is an NSAID and can increase the risk of GI ulceration and bleeding. A history of peptic ulcer disease or GI bleeding is an important safety concern.
The nurse is preparing to administer enoxaparin subcutaneously. Which site should the nurse select?
A. Deltoid muscle
B. Abdomen
C. Dorsogluteal muscle
D. Inner forearm
B.
Rational: Enoxaparin is administered into subcutaneous abdominal tissue, following product instructions for distance from the umbilicus (usually 1 in) and site rotation.
A medication order reads “Tuberculin PPD 5 TU/0.1 mL.” The nurse inserts the needle bevel-up at a 5–15° angle and observes a small wheal. What route was used?
Intradermal
The nurse is preparing NPH and Regular insulin in the same syringe. Which insulin should be drawn up first?
Regular insulin.
Remember: Clear before cloudy!
Order: Ketorolac 30 mg IM now. Available: Ketorolac 60 mg/2 mL. How many mL will the nurse administer?
1 mL
A patient with diabetes has a prescription for Regular insulin before breakfast. The nurse prepares to administer the medication. Which statement about Regular insulin is correct?
A. It should only be administered intravenously.
B. It is a long-acting insulin used primarily for basal coverage.
C. It can be administered subcutaneously and may also be administered IV in certain clinical situations.
D. It should always be mixed with insulin glargine before administration.
C.
Rational: Regular insulin is short-acting and is commonly administered subcutaneously. Unlike most other insulin formulations, Regular insulin can also be administered IV in appropriate clinical settings, such as treatment of DKA.
It may be mixed with NPH when prescribed, but glargine should not be mixed with other insulins.
The nurse is preparing to administer an influenza vaccine into an adult patient's deltoid muscle. How should the nurse locate the appropriate injection site?
A. Locate the umbilicus and move 2 inches laterally
B. Locate the acromion process and identify the thickest portion of the deltoid below it
C. Locate the greater trochanter and anterior superior iliac spine
D. Locate the patella and move laterally
B.
Rational: The nurse first identifies the acromion process and administers the injection into the thick central portion of the deltoid, avoiding placement too high or too low.
The nurse needs to administer 2 mL of medication into muscle tissue. The patient's deltoid has very little muscle mass. What route and alternative site would be more appropriate?
IM; ventrogluteal or vastus lateralis, based on patient assessment and facility policy.
While an IV is infusing, the patient reports discomfort. The nurse notices the IV site is cool, swollen, and pale. What complication should the nurse suspect?
Infiltration.
Order: Heparin 7,500 units subcutaneously. Available: Heparin 10,000 units/mL. How many mL will the nurse administer?
0.75 mL
The nurse is preparing to administer insulin lispro to a patient before breakfast. Which action is most appropriate?
A. Administer the insulin even though the patient's breakfast has been delayed for 2 hours.
B. Ensure the patient's meal is available when the insulin is administered.
C. Administer the medication at bedtime regardless of food intake.
D. Hold the insulin because rapid-acting insulin should only be administered after meals.
B.
Rational: Lispro is a rapid-acting insulin. Because it begins working quickly, food should be readily available when it is administered to decrease the risk of hypoglycemia. Timing should follow the ordered regimen and product instructions.
The nurse needs to locate the vastus lateralis for an IM injection. Which technique is correct?
A. Divide the area between the greater trochanter and knee into thirds and use the middle third of the anterolateral thigh.
B. Locate the acromion process and inject two finger widths below it.
C. Locate the umbilicus and inject immediately beside it.
D. Divide the buttock into four quadrants and use the lower inner quadrant.
A.
Rational: The vastus lateralis is located on the anterolateral thigh. The middle third between the greater trochanter and knee is used for IM administration.
The nurse is preparing to administer a subcutaneous insulin injection. Which needle is most appropriate?
A. 18 gauge, 1½ inch
B. 25 gauge, 1 inch
C. 28 gauge, ½ inch
D. 22 gauge, 1½ inch
C.
Rational:
Subcutaneous injections generally use a short, fine needle. Depending on the medication/device, commonly encountered SQ needles are approximately 25–31 gauge and 3/8–5/8 inch.
A patient receiving an opioid becomes extremely difficult to arouse and has slow, shallow respirations. Which medication should the nurse anticipate administering?
Naloxone
Order: Ceftriaxone 750 mg IM now. Available after reconstitution: Ceftriaxone 350 mg/mL. How many mL will the nurse administer? Round to the nearest tenth.
2.1 mL
The nurse begins administering penicillin to a patient. Several minutes later, the patient develops wheezing, facial swelling, and difficulty breathing. Which action should the nurse take first?
A. Document the reaction in the medical record
B. Slow the medication administration
C. Stop the medication and initiate emergency management for suspected anaphylaxis
D. Ask the patient whether this has happened before
C.
Rational: Wheezing, facial swelling, and difficulty breathing following penicillin administration suggest anaphylaxis, which can rapidly become life-threatening. The medication should be stopped and emergency treatment initiated. Epinephrine is the first-line medication for anaphylaxis.
The nurse is preparing to administer an IM medication using the ventrogluteal site. Which action correctly identifies the landmarks?
A. Place the palm over the greater trochanter, point the index finger toward the anterior superior iliac spine, and spread the middle finger along the iliac crest.
B. Locate the acromion process and measure approximately two to three finger widths below it.
C. Divide the posterior buttock into four equal quadrants.
D. Locate the greater trochanter and measure directly toward the knee.
A.
Rational:For the ventrogluteal site, the nurse uses the greater trochanter, anterior superior iliac spine, and iliac crest as landmarks. The injection is administered in the center of the “V” formed by the fingers.
The nurse is preparing to administer an IM medication into the ventrogluteal muscle of an average-sized adult. Which needle would be most appropriate?
A. 25 gauge, ⅝ inch
B. 22 gauge, 1½ inch
C. 28 gauge, ½ inch
D. 18 gauge, ½ inch
B.
Rational:
IM injections need a needle long enough to pass through subcutaneous tissue and reach the muscle. A common range for adults is approximately:
22–25 gauge | 1–1½ inches
The exact length depends on the site, patient's body size, amount of adipose tissue, and medication.
A patient begins receiving penicillin and suddenly develops wheezing, facial swelling, and difficulty breathing. What should the nurse suspect? What medication would the nurse anticipate administering?
Anaphylaxis & Epinephrine
Order: 1,000 mL normal saline IV over 8 hours. Available: IV tubing with a drop factor of 15 gtt/mL. What is the flow rate in gtt/min?
31 gtt/min
The nurse administers naloxone to a patient experiencing opioid-induced respiratory depression. Five minutes later, the patient's respiratory status improves. Which action is most important for the nurse to take next?
A. Discharge the patient because the opioid effects have been reversed
B. Continue to monitor respiratory status because opioid effects may return
C. Administer an opioid immediately to prevent withdrawal
D. Encourage the patient to ambulate to increase respirations
B.
Rational: Naloxone's duration of action may be shorter than that of the opioid responsible for the toxicity. Respiratory depression can therefore recur after the naloxone wears off. The patient requires continued monitoring, and additional naloxone doses may be necessary.
The nurse is preparing medications for four patients. Which medication, route, and injection site are correctly matched?
A. Tuberculin PPD — IM — deltoid
B. Enoxaparin — SQ — abdomen
C. Influenza vaccine — intradermal — inner forearm
D. Ketorolac — SQ — abdomen
B.
Enoxaparin is administered subcutaneously in the abdomen. The others are mismatched:
PPD → ID → forearm
Influenza vaccine → IM → typically deltoid in adults
Ketorolac → may be IM → appropriate IM site based on patient/volume
The nurse is preparing to administer a PPD skin test. Which needle would be appropriate?
A. 26 gauge, ⅜ inch
B. 21 gauge, 1½ inch
C. 22 gauge, 1 inch
D. 18 gauge, 1 inch
A.
Rational:
Intradermal injections require a very short, fine needle because the medication is placed just beneath the epidermis.
A commonly taught range is approximately 25–27 gauge and ¼–½ inch, depending on equipment and institutional guidance.
A patient received insulin lispro before breakfast. Thirty minutes later, the patient becomes shaky, sweaty, confused, and complains of feeling very hungry. What should the nurse suspect, and what should the nurse do first?
Suspect hypoglycemia. Check the patient's blood glucose immediately and treat according to the hypoglycemia protocol.
Cold and Clammy, need some candy!